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NASW Advocates with Blue Cross Blue Shield of Massachusetts

Blue Cross Blue Shield of Massachusetts has recently notified providers that they are rolling out an Outcomes Management Program in Behavioral Health Care. The NASW Massachusetts Chapter has been receiving many calls regarding this information. Please be assured that the Chapter Staff and Executive Board have been meeting with BCBSMA since December 2006 on this new initiative. We have discussed the many concerns of our members with BCBSMA and have participated in a multidisciplinary meeting with the other professional organizations in Massachusetts. NASW members will also have representation on the Scientific Advisory Council that will continuously evaluate the tool and the data obtained. NASW has been committed to working collaboratively with BCBSMA on the Outcomes Measurement Tool so that it can be an effective and useful endeavor.

BCBSMA has provided the following additional information to the mailing that was sent in May for NASW members.

BCBSMA Introducing Outcomes Management in Behavioral Health Care

Blue Cross Blue Shield of Massachusetts (BCBSMA) has launched a behavioral health (BH) outcomes management program to help enhance the quality and effectiveness of care our members receive during visits with BH clinicians. This program offers an enhanced fee schedule to outpatient behavioral health providers who participate in the program. The goals of this program are to:

· Offer providers a validated, risk-adjusted measure of the effectiveness of treatment.

· Identify members at risk for poor outcomes and offer them Case Management Services

· Enable members to play an active role in their treatment giving the provider reports that they can share with the member to track progress.

· Demonstrate the value of effective outpatient care.


Privacy/Confidentiality to be Protected

BCBSMA has gone through an extensive process of consultation with providers about this program. To protect member privacy and confidentiality, BCBSMA will receive only:

· Notice that a member has completed and submitted an instrument, with a score between 1 and 5 indicating the likelihood that the member would benefit from Case Management services

· De-identified patient instrument scores to help us assess the impact of effective outpatient treatment on medical and behavioral health utilization.

BCBSMA will not receive actual member questionnaire responses or scores in patient-identifiable form.

Part of National Healthcare Trend

This effort reflects a trend in all healthcare fields to ensure that patients receive clinically appropriate care and to reflect differences in quality and effectiveness in provider reimbursement. BCBSMA has already introduced outcomes measures in other provider incentive programs, including our primary care providers and group practice-based provider programs. The Institute of Medicine clearly calls for the use of standardized outcomes measures in the treatment of behavioral disorders.

Behavioral Health Laboratories (BHL), a leading behavioral health outcomes measurement company, will work with us on this program. BHL’s Treatment Outpatient Package (TOP) is currently used in Massachusetts by more than 5,000 clinicians and is the preferred outcomes tool of the Massachusetts Behavioral Health Partnership.


If you would like more information about the TOP’s scientific validity, the registration process, or integrating the TOP in practice, go to If you do not have Internet access or have registration questions, call BHL at 1-800-329-0949.

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